Key result
Positive high-sensitive cardiac troponin I was associated with a significantly higher likelihood of ICU admission in patients with pulmonary embolism (RR 3.7; 95% CI 2.1-6.5).
Why the study?
Pulmonary embolism carries a major burden of morbidity and mortality, making prompt risk stratification and evaluation of risk management and disposition in the emergency department crucial.
Does the combination of hs-cTnI and PESI score improve risk stratification and final disposition decision-making compared to PESI score alone in patients with pulmonary embolism in the Emergency Department?
Observational (n=374)
Does the combination of hs-cTnI and PESI score improve risk stratification and final disposition decision-making compared to PESI score alone in patients with pulmonary embolism in the Emergency Department?
Relative Risk: 3.7 (95% CI 2.1–6.5)
Combining high-sensitive cardiac troponin I with the PESI score improves risk stratification in acute pulmonary embolism, identifying higher-risk patients requiring ICU admission who might otherwise be misclassified by PESI alone.
May aid ED risk stratification and disposition for PE; leaves open need for larger multicenter validation.
BACKGROUND AND OBJECTIVES: Pulmonary embolism (PE) has a major burden of morbidity and mortality, consequently the need for a prompt risk stratification for these subjects is crucial. In order to evaluate the risk management and final disposition of patients with PE in the Emergency Department (ED), we conducted a study that was divided in two phases: Phase I retrospective study (RS), Phase II prospective study (PS). MATERIALS AND METHODS: In Phase I, 291 patients were enrolled while in Phase II, 83 subjects were evaluated. In both study phases, the enrolled subjects were analyzed for final disposition in ED using PESI score, right ventricle (RV) imaging, and high-sensitive cardiac troponin I (hs-cTnI) data. The RS patients were divided into low risk and high risk according to the sPESI score, while PS patients were grouped in low, intermediate, and high risk classes according to PESI score. In both study phases, all the studied patients were further divided into negative (hs-cTnI-) or positive (hs-cTnI+) groups according to hs-cTnI levels within normal or above cutoff values, respectively. For all enrolled subjects, CT pulmonary angiography was analyzed to assess the RV/LV diameter and volume ratio as an indicator of RV involvement. RESULTS: In both RS and PS phases, hs-cTnI+ group showed a higher PESI score. Nevertheless, a significant percentage of hs-cTnI+ patients resulted to be in the low-risk PESI class. Patients with a positive RV/LV ratio were more likely to have a hs-cTnI+ (p < 0.01), while among those with a negative ratio, 24 to 32% showed as hs-cTnI+. In the hs-cTnI+ group from both study phases, patients were more likely to be admitted in an ICU (RR 3.7, IC: 2.1-6.5). CONCLUSIONS: In conclusion, in patients with PE in the ED compared PESI score alone, the combination of hs-cTnI and PESI seems to be of greater utility in improving risk stratification and final disposition decision-making.
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Cennamo et al. (2023) conducted an observational in Pulmonary embolism (n=374). Positive high-sensitive cardiac troponin I (hs-cTnI+) vs. Negative high-sensitive cardiac troponin I (hs-cTnI-) was evaluated on ICU admission (RR 3.7, 95% CI 2.1-6.5). Positive high-sensitive cardiac troponin I was associated with a significantly higher likelihood of ICU admission in patients with pulmonary embolism (RR 3.7; 95% CI 2.1-6.5).
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